<%@ page language="java" contentType="text/html; charset=ISO-8859-1"
	pageEncoding="ISO-8859-1"%>
<%@taglib prefix="s" uri="/struts-tags"%>
<%@taglib prefix="sj" uri="/struts-jquery-tags"%>
<%@taglib prefix="sjg" uri="/struts-jquery-grid-tags"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
<title>Insert title here</title>
</head>
<body>
	<s:form theme="simple">
		<table>
			<tr>
				<td>Service Benefits Critetion</td>
				<td>
				<fieldset>
					<s:checkbox name="3">Contact 1</s:checkbox>
					 <br>
					 <s:checkbox name="4">Contact 2</s:checkbox>
				</fieldset>
				</td>
				<td>Service Disability Critetion</td>
				<td>
				<fieldset>
					<s:checkbox name="3">Contact 1</s:checkbox> 
					<br> 
					<s:checkbox	name="4">Contact 2</s:checkbox>
				</fieldset>
				</td>
			</tr>
			<tr>
				<td>Service Barriers Criterion</td>
				<td>
				<fieldset>
					<s:checkbox name="3">Contact 1</s:checkbox> 
					<br> 
					<s:checkbox	name="4">Contact 2</s:checkbox>
				</fieldset>
				</td>
				<td>Service Personal Circumstants Criterion</td>
				<td>
				<fieldset>
					<s:checkbox name="3">Contact 1</s:checkbox> 
					<br> 
					<s:checkbox	name="4">Contact 2</s:checkbox>
				</fieldset>
				</td>
			</tr>
			<tr>
				<td>Service Ethnicity Criterion</td>
				<td>
				<fieldset>
					<s:checkbox name="3">Contact 1</s:checkbox> 
					<br> 
					<s:checkbox	name="4">Contact 2</s:checkbox>
				</fieldset>	
				</td>
				<td>Other Service Participation Criterion</td>
				<td>
				<fieldset>
					<s:checkbox name="3">Contact 1</s:checkbox> 
					<br> 
					<s:checkbox	name="4">Contact 2</s:checkbox>
				</fieldset>	
				</td>
			</tr>
		</table>
	</s:form>
</body>
</html>